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19301 POST THIS CARD NEAR FRONT OF BUILDING P TN193O1 P RTI - CITY OF CUE NO . INSPECTION DIVISION- JOB INSPECTION RECORD' / G� t�l� "0 JOB ADDRESS ZO / �--" UNIT# LOT# - CATEGORY -/. CONTROLN OWNER. 'CONTRACTOR L 0� BUILDING PERMIT INFO ECORD OUNDATION/PIERS - DATE INSPECTOR NOTE-ALL GRADNG INSPECONAND DRAINAGE�^ '- : UFER'GROUND SF TALI:BE INSTALLED TO COMPLY WITH _ JOB DFSCIEPTION THE APPROVED PLANS AND CITY OF ' PAD/SETBACK-CERT . - �' CUI'ERTINO STANDARDS. •� _ "GARAGE SLABS PRBGUNITE � - - "POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - UNDERGROUND/SLAB- INSPECTION DATE INSPECTOR PLUMBING ELECTRICAL h " MECHANICAL ' - - DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR PLUMBING - MECHANICAL ELECTRICAL FRAMING/VENTS/CLEAR INSULATION - - PLACE-NO SIIBFLOORUNTIL ABOVEHAS BEEN SIGNED. ROUGH " PLUMBING TUBS&SHOWER PAN- MECHANICAL ELECTRICAL JACUZZI BOND FRAMING STAIRS INSULATION/VENTILATION _ • EMERG.EGRESS - - SEWER WATER - - - COVER NO•.WORK"""UNTIL,ABOVE HAS BEEN SIGNED. EXTERIOR SHEAR HOLD DOWN _ - INTERIORSHEAR/HOLD DOWN " - SI-IEETROCK/SHEETROCK SHEAR EXTERIOR LATI-I/W-SCREEN - - SHOWER LATH �a , SCRATCH COAT - - NO'TA'PF•.OR PLAST RSUNTIL ABOVE HAS BEEN SIGNED NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID - FINALS I DATE INSPECTOR - .. SAN.# ELECT.ENERGY PLUMBING ENERGY - MECH.ENERGY BUILDING ENERGY _ ELECT:FINAL TEST _ PLUMBING , CAS TEST - MECHANICAL .. 1-ICATING 7ELECTRICAL RELEASE' ' - GRADE _ .. OCCUPANCY " TEMPORARY APPROVALS ELECTRIC GAS - - BUILDING - J;•~.- OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE DATE BUILDING FINAL IS SIGNED RY BUILDINC. INSPECTOR - ARRANGE FOR INSPECTION BY PHONING 252-4505 f BETWEEN 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS BEFORE REQUIRED,INSPECTION. JOB ADDRESS AND PERMIT# ARE NEEDED WHEN PHONING: IMPORTANTI PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUEDBY: + - OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY �I Building Project Identification - , a'., PERMIT NO.193.01.. o�aa S t e fJw ere a - Phone: - A 7 — s CITY OP CUPERTINO-BUILDING DIVISION j- /�. �• -� :09or'a Nar Gc.No. APPLICATION /,PERMIT �I Architect/Engineer. - BUILDING-ELECTRICAI.PLUMBINC MECIIAMCAL CATEGORY CONTROL N Lic.No: .iELECTRIC PER MIT 'FEE - • BUILDING PERMIT INFO- Address: +' - PERMITISSUANCE El Elp 1' LICENSED CONTRACTOR'S DECLARATION ]hereby affirm that l am licensed under provisions of Chapter 9(commenc- APPLIANCES-RESIDENTIAL ]OB DESCRIPTION - IngwithSedion7000).MD i,ion3ofthe BusinemandProfesslonsCode,andmy - -IicenseisinfuR(omeandeffect. PANELS License Class LieN rl•I� F1 1-�^"I� Data Lie. - , l J /til ARCHITECPS DECLARATION201-1000 AMPS ' o' Licensed Professbral Z I understand my plans shall be used as public records. OVERIODOAMPS SQ Fr.FLOOR AREA - $/SQ.FT � . gipp�±± SIGNS ELECTRICAL: u Fi � � - - ;' ' I�<< OWNER-BUILDER DECLARATION SPECIALCIRCUFE/MISC Iherebyafflrmthallamexemptlromthe Contractoraldcenm Ul forthe - 'Z following reason.(Section 7031.5 Business and _ oo g (Se n r,Professions Code.Any city O Zu9 countywhkh requlresapermitto corutmct,alter,improve,dennWh,or repair T�P.METEROR POLE]NST., ' g���''u a nyslmcturepriortoitsissuares,a)sorequlose the applicant for such permit to I. E5 O file a signed statement that he V licensed pursuant to the.proNsime o! the POWER DEVICES 3w Contractors License Law(Chapter 9(cormnencin SWIMMING IY)O with Section 7000)of Divi= �.0 sion 3 of the Business and PeracmbwCods)or that he is exemptlhere(rom and L ELECTRIC VALUATION O 5 the basis for the alleged exemption. Any violation of Section 7031.5 by any ' applicant fora perrNOITILE'(S5WITCFIFSt subj"the applicant to a civil penalty of not rrorethen OQ JI ve dre1,aso demodollarhere - SQ. - STORIES TYPE CONSTRUCTION R ' -JrNEW RESIDENTIAL ELEI FC. I,as owner of the property,omy employees with wages r their sok 7a compeneallon,wllldothe work.and/heslructure is not or offend for O sale(Sec.7044,Business and Profemims Code.The Contractors License Law ] r^� does not apply to an owner of properly who builds or improves thereon,and 3^ who does such work hirraelforthrough his own employee,,provided that such OCC.GROUP .RES UNITS improvements arenotln{ended oroffened forsale.If,howevegthebulldinger TOTAL: �,�,� mprovereentissold within oneyearofcompietion,theowner-buRderwill have lhgpurden of proving that he did net build or Improve for purpose of sale.).' QTY, PLUMBINC PERMIT ' FEE - FLOOD ZONE APN I,as owner of the property,am exclusively contracting with.11mnsed PERMIT ISSUANCE root coon to construct the project(See.7044,Business and Professions Code: , The Contractor's License Law does net apply to an owner of property who , ALTER-DRAW k VENT•WATER(EA) .bunds or Improves thereon,and who contract, for such projects with . V FEE SUMMARY ' cgplfa&or(.)licensed purouant to the ContratlorY License Law. BACK FLOW PROTECT.DEVICE' ' IJ I am exempt under Sec. B 4 P C ar thy$ nOUTSIDE FEES /. N - /... n' I /in DRAINS FLOOR A00$ARFA,COND - SANITARY - Y N . Owner RECFR'f N WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOLTAX Y_ N ❑I hereby affirm that 1 have onlas car of consent to seR-ineure;ora - RECEIPT N rerttflLab of Workers Comperwtlonlwuvnce oramnifled ropythemo((Sec. GAS FA.SYSTEM-1 INC,40UTLEm 3olicyN J i - PARKFEF Y_ N RECEIPT a ceffs - GAS EA.SYSTEM.OVER 4(EA) DING DIV Com any V BUILDING DIVISION FEES ❑pCertlfled copykhereby furnished. GREASE/INDUSTRLWASTE INTERCEPTOR - PLANCHECK FEE:. -❑Certified copy is flied with the city Inspection division. _ ., 'CERTIEICATEOF E3( MPTION 17ROM WORKERS'- GREASE TRAP �, - PAID COMPENSATION INSURANCE, SEWER-SAMTARY-STORM EA.MEET, Dell -Recei I# : .(This section need not be completed if the permit k for one hundred dollars ($100)er.less.) wA'rntHEATIR WiVENT/Ei.Ixra ENERGY FEE Y N' I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so m to become subject to the WATER SYSTEM/TRGTING Workers'Compereation Laws of California.Date PAID Z Z' Applicant - x NEW RESIDENTIAL PLMB. SQ.FT. Date .Rece3 f# O NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should become subject to the Workers'Coropereation provisions of the Labor ' ' TOTAL Codqyoumustfahwithromply,[thsuchprovisionsorihispermltahallbc r ILD] G LU > deemed revoked. - _ ,. ' d c CONSTRUCTION LENDING AGENCY - SEISMIC FEE I hereby afllrmthat there is a construction lending agency for the perform- ELEC'T'RIC FEE Zanceoftheworkforwhkhthispermdlsissaed(Sec.3097,CIv.C.) { TOTAL: �C -U O• LendereName PLUMBING FEE LL I- Lendcr9Address QTY. MECHANICAL PERMIT , FEE MECHANICAL FEE' O W' Irertlfythatl have read this applkatlenand statethattheabove information i ' . . 1 Is correct.I agrecto comply with aBUty and county ordinances and state laws PERMIT ISSUANCE _ F�EE�S•'PA�Ia?.�: N relating tobullding emotruction,and hereby authorize representatives o(thls I— Z citytoenterupon the above-mentioned property for lnspeNon purposes. - ALTER OR ADD TO MECH. ' ��a—���� (we)agree to save,indemnify an d keep harmless the City of Cupertino - - Dale I(CC2jP1# V againstliabilities,prdgments,costsand expenses which may In any wayaccrus AIR HANDLING UNIT cro 10000 CFM) SUBTOTAL: against said City in consequence of the granting of this permit. - AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX Signature of Applicant/Contractor - Date EXHAUST HOOD MI DUCT) CONS1TRUC21ON TAX PAID: HAZARDOUS MATERIALS DISCLOSURE ,939 ,'.-. Will the applicant or future building occupant store or handle hazardous" IIEATINGUNI H0100,000BTU) - imaterial as defined by the Cupertino Municipal Code,Chapter 9.12,and the Dete ,RICE] I# He❑alt,annd Safety Code,Secton 25532(a)? HEATING UNIT(OVER 100,000 BTU) .TOTAL: ZI® Will the applicant orfuturebullding occupant use equipment ordevicas_ VFN7ILATION FAN(SING LE RESID) ISSUANCE DA'L'E . which emit harardouasirconlamindnlsas defined bytho Bay Area Air - QualityManagementDistrict? - BOILER-COMP(3HPOR 100,000 BTU) - -. ]�Yes ®No r ' Shave read the hazfrdods materials requirsencoue under Chapter 695 of BOILER-COMP(OVER 100,000 BTU) the California Health&Safety Code,Sections 25505,75533 and 25534.I - understandthatlfthe building does not currently have a tenant,that It is my NEW RESIDENTIAL MECH. SQ.FT., - rexponsini ty to notify the occupant of the requirements which must be met prior to ss,a CertiRcate otOmpanry. /� I �or aut�gent Cars ISSUEDB - TOTAL: OFFICE COPY